- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04009343
Pharmacokinetics and Pharmacodynamics of the Gametocytocidal and Post-treatment Chemoprotective Effects of Antimalarials
November 28, 2023 updated by: Johns Hopkins Bloomberg School of Public Health
Field Study of the Pharmacokinetics and Pharmacodynamics of Artemisinin-based Combination Therapy for Gametocyte Clearance and Post-treatment Chemoprotection in Zambian Children With Uncomplicated Falciparum Malaria
Single-center phase II/III clinical investigation of the pharmacokinetics and pharmacodynamics of artemether-lumefantrine and dihydroartemisinin-piperaquine for gametocyte clearance and post-treatment chemoprotection in Zambian children with uncomplicated falciparum malaria.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
Detailed Description
Artemisinin-based combination therapies (ACTs) are the first-line agents for uncomplicated falciparum malaria.
Artemether-lumefantrine (AL) is the most widely adopted ACT in sub-Saharan Africa for case management.
Dihydroartemisinin-piperaquine (DP) is increasingly used for mass drug administration in malaria eliminating regions, and is being explored as a candidate for intermittent preventive therapy.
AL and DP possess similar clinical efficacy against uncomplicated falciparum malaria in areas of drug susceptible parasites.
However, AL appears to clear gametocytes (the transmissible stage of the malaria parasite) more rapidly than DP, while DP confers a longer duration of post-treatment protection against reinfection.
It is not known whether the observed difference in gametocyte clearance between AL and DP is due to pharmacokinetic (PK) and/or pharmacodynamic (PD) differences of the artemisinin derivatives, PK/PD features of the non-artemisinin companions, or contributions from both.
The longer duration of protection against reinfection provided by DP is due to the long elimination half-life of the partner drug, but further characterization of its relative benefit in high-transmission settings compared to AL is needed to inform malaria drug policy.
The investigators are conducting a single-center randomized controlled clinical trial comparing the efficacies of AL and DP for gametocyte clearance and post-treatment chemoprotection among 6- to 59-month-old children with uncomplicated falciparum malaria in a high malaria transmission area of northern Zambia.
Children with microscopy-confirmed Plasmodium falciparum monoinfection will be admitted for 72 hours for directly observed therapy with either AL or DP and serial sampling for parasite clearance and multi-dose PK measurements.
Twenty children from each arm will be recruited to an intensive PK subgroup.
Participants will be followed for 9 weeks for outcome assessment according to World Health Organization-defined clinical endpoints and to measure clearance of the long-acting partner drugs.
Parasite genotyping will be done to distinguish recrudescence from reinfection and query genetic markers of drug resistance.
Participants will contribute fecal specimens to help investigate bidirectional associations between the intestinal microbiota and antimalarial drug pharmacokinetics, as well as enterotype association with risk of reinfection.
Study Type
Interventional
Enrollment (Estimated)
182
Phase
- Phase 2
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Copperbelt
-
Ndola, Copperbelt, Zambia
- Tropical Diseases Research Centre
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
6 months to 4 years (Child)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Weight ≥10 kg
- Any indication for malaria diagnostic testing as determined by a treating provider (e.g., fever or history of fever)
- P. falciparum parasitemia (by microscopy) of any density not meeting criteria for severe malaria
- Ability to swallow oral medication
- Ability and willingness of parents or guardians to comply with study protocol for the duration of the study and to comply with the study follow-up visit schedule
- Residence within hospital catchment area
- Signed informed consent obtained from a legal representative of the participant
Exclusion Criteria:
- Complicated or severe falciparum malaria as defined by WHO criteria
- Hemoglobin concentration < 7 g/dL
- Use of any drug with antimalarial activity within the prior 4 weeks
- History of hypersensitivity reaction or intolerance to AL or DP
- Co-infection with Plasmodium spp. other than P. falciparum as determined by microscopy
- Confirmed or suspected concurrent acute infection other than malaria (e.g. measles, acute lower respiratory tract infection)
- Current therapy with QT interval-prolonging agents
- Family history of sudden cardiac death or personal history of cardiac disease
- Residence outside the study area, or plan to leave the study area
- Residence in foster care or otherwise under government supervision
- Previous enrollment in the study, or enrollment in any other investigational drug trial during the previous 30 days
- Presence of any other condition or abnormality that in the opinion of the investigator would compromise the safety of the participant or the quality of the data
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Artemether-lumefantrine
Standard 6-dose regimen
|
Children will receive artemether-lumefantrine (20/120 mg) dosed according to weight (5 to <15 kg: 1 tablet, 15 to <25 kg: 2 tablets) at 0, 8, 24, 36, 48 and 60 hours.
Medications will be administered according to the manufacturer's instructions.
Other Names:
|
Experimental: Dihydroartemisinin-piperaquine
Standard 3-dose regimen
|
Children will receive dihydroartemisinin-piperaquine (40/320 mg) dosed according to weight (5 to <8 kg: 1/2 tablet, 8 to <11 kg: 3/4 tablet, 11 to <17 kg: 1 tablet, 17 to <25 kg: 1 1/2 tablets) at 0, 24, and 48 hours.
Medications will be administered according to the manufacturer's instructions.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Treatment outcome
Time Frame: 9 weeks
|
Defined according to World Health Organization (WHO) classification as adequate clinical and parasitological response, early treatment failure, late clinical failure, or late parasitological failure corrected by genotyping to distinguish reinfection from recrudescent infection.
|
9 weeks
|
Area-under-the-curve (AUC) of the gametocyte concentration-time curve
Time Frame: 72 hours
|
Primary gametocyte-related pharmacodynamic (PD) endpoint of the study
|
72 hours
|
Incidence of reinfection during the 9-week follow-up period
Time Frame: 9 weeks
|
Primary measure of the post-treatment chemoprotective effect of the drugs
|
9 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Elimination half-life of the gametocyte concentration-time curve
Time Frame: 72 hours up to 9 weeks for those with persistent gametocytemia
|
Alternative PD outcome of gametocyte dynamics
|
72 hours up to 9 weeks for those with persistent gametocytemia
|
Change over time of the gametocyte sex ratio (female:male)
Time Frame: 72 hours up to 9 weeks for those with persistent, emergent, or recurrent gametocytes
|
The ratio of female and male gametocytes over time during treatment is a hypothesized marker of transmissibility
|
72 hours up to 9 weeks for those with persistent, emergent, or recurrent gametocytes
|
Elimination half-life of the asexual parasite concentration-time curve
Time Frame: 72 hours
|
In addition to gametocyte dynamics, asexual parasite dynamics and how they relate to PK parameters and other covariates with also be examined
|
72 hours
|
Allele frequency of genetic markers of parasite drug resistance in initial vs. recurrent parasites and fast vs. slow clearing parasites
Time Frame: 9 weeks
|
Relative barriers to drug resistance of AL and DP will be tested using known and newly described parasite genetic markers of resistance and association with phenotypic susceptibility
|
9 weeks
|
Incidence of treatment-emergent adverse events (safety and tolerability)
Time Frame: 9 weeks
|
We will assess adverse events and serious adverse events associated with the study drugs in accordance with the WHO Toxicity Grading Scale for Determining the Severity of Adverse Events
|
9 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
AUC of the plasma concentration-time curve
Time Frame: 72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
Pharmacokinetic (PK) endpoint of the study, determined for each drug and drug metabolite
|
72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
Peak plasma concentration (Cmax) of study drugs and metabolites
Time Frame: 72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
PK endpoint of the study, determined for each drug and drug metabolite
|
72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
Oral clearance (Cl/F) for all drug analytes
Time Frame: 72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
PK endpoint of the study, determined for each drug and drug metabolite
|
72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
Nutrition status-related associations with drug PK
Time Frame: 72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
In nonlinear mixed effects PK models, we will test associations between nutrition status (weight-for-age Z score) and drug PK parameters
|
72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
Body surface area-related associations with drug PK
Time Frame: 72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
We will test, in nonlinear mixed effects PK models, associations between body surface area and drug PK
|
72 hours (artemisinin derivatives) and 9 weeks (long-acting companions)
|
Gut microbiota enterotype
Time Frame: 9 weeks
|
We will characterize the gut microbiota of study participants and examine bidirectional associations between enterotype and drug PK, and enterotype and incidence of reinfection
|
9 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: William J Moss, MD MPH, Johns Hopkins Bloomberg School of Public Health
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
June 19, 2019
Primary Completion (Actual)
August 24, 2020
Study Completion (Estimated)
July 1, 2024
Study Registration Dates
First Submitted
June 7, 2019
First Submitted That Met QC Criteria
July 3, 2019
First Posted (Actual)
July 5, 2019
Study Record Updates
Last Update Posted (Actual)
November 30, 2023
Last Update Submitted That Met QC Criteria
November 28, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 7663
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
Individual participant data will be made available to other researchers upon reasonable request.
Parasite clearance and drug resistance data will be contributed to the Worldwide Antimalarial Resistance Network database.
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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